Provider Demographics
NPI:1033222369
Name:HOUSRI, IBRAHIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:A
Last Name:HOUSRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-2516
Mailing Address - Country:US
Mailing Address - Phone:973-887-3883
Mailing Address - Fax:973-887-6306
Practice Address - Street 1:28 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-2516
Practice Address - Country:US
Practice Address - Phone:973-887-3883
Practice Address - Fax:973-887-6306
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2952203Medicaid
NJ2952203Medicaid
C56189Medicare UPIN